GENITOURINARY TUBERCULOSIS - EXPERIENCE WITH 52 UROLOGY INPATIENTS

The current trend in South African health services is toward primary c are. Pulmonary tuberculosis is well understood by the majority of prim ary care doctors and nurses, whereas genito-urinary tuberculosis may n ot be as easy to diagnose and treat. We reviewed our experience with t his condition in 52 patients, who represented 0,74% of urology admissi ons between 1986 and 1991. There was a 3:2 male/female ratio, the age range was 7-76 years (mean 43 years), and the disease was more common among blacks and coloureds than among whites. Multiple sites of involv ement were fairly common. Seventy-five per cent of patients had renal involvement and 17% epididymal involvement. The commonest presenting c omplaints were urinary frequency and haematuria, although flank and sc rotal pain were also reported by a number of patients. Physical examin ation seldom helped to suggest the diagnosis. On microscopic examinati on and culture of the urine, sterile pyuria was present in only 50% of our patients and 29% had positive cultures for a 'normal' coliform or ganism. Fifty patients underwent excretory urography and the findings were very varied. Patients were treated primarily with antituberculosi s drugs, but 58% also required some form of surgery; nephrectomy was t he commonest operation. Ureteral strictures developed in over 50% of c ases with renal involvement. We conclude that the diagnosis of genito- urinary tuberculosis is not simple, and that treatment must include re gular follow-up at a specialist institution.